Medial-plantar plate for medial column arthrodesis

ABSTRACT

An article comprises a unitary plate configured to conform to a foot of a patient. The plate has a dorsal portion shaped to conform to a dorsal surface of a medial column of the foot and a plantar-medial portion shaped to conform to a medial surface of a first metatarsal of the foot and extend to a plantar surface of the first metatarsal. The plantar-medial portion is integrally attached to the dorsal portion. The plate has a plurality of apertures for receiving screws. The apertures include: a plurality of first apertures through the dorsal portion, adapted to receive a respective one or more first screws to be inserted into a dorsal surface of a talus of the foot, and at least one second aperture adapted to receive a second screw inserted through a plantar end of the plantar-medial portion into a first metatarsal of the foot.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a division of U.S. application Ser. No. 14/420,240,filed Feb. 6, 2015, which is a national phase entry under 35 U.S.C. §371 of international patent application no. PCT/US14/55141, filed Sep.11, 2014, the entireties of which are incorporated herein by reference.

FIELD

This application pertains generally to medical devices, and moreparticularly to an implant plate for use in medial column arthrodesisprocedures, such as fusing damaged, deteriorating, or fractured talus,navicular, cuneiform and/or metatarsal bones.

BACKGROUND

Arthrodesis is a surgical procedure for artificially inducing jointossification between two bones. Arthrodesis may be performed to relievepain in a joint which cannot be managed by more conservative approaches,such as medication, splints, or the like. The typical causes of suchpain are fractures which disrupt the joint, and arthritis. Arthrodesismay be performed for fusing damaged, deteriorating, or fractured tibia,talus and calcaneus bones in the ankle region. Arthrodesis may be usedto treat Charcot midfoot deformity, including bone resection and/orosteotomy to reduce deformity.

Arthrodesis procedures often include fastening a bone plate to thesurface of a bone, typically at both sides of a joint line to supportand/or stabilize the joint. Bone plates have often been attached to thebones with bone screws that extend from the plate into the bone. In someexamples, the head of the bone screw is locked to the plate (e.g., bythreaded engagement between the screw head and the bone plate) and inother plates the head of the screw is free to angulate with respect tothe plate, such that a polyaxial screw may be placed in the bone at asurgeon-selected angle. In yet other examples, the screw head maycooperate with the bone plate to provide compression or distraction ofthe joint (i.e., to push the bone fragments towards or away from oneanother).

Bone plates stabilize the treated bones to prevent relative motionbetween the bones during the prolonged fusion period, which may last forseveral months. Patients are typically advised to keep weight off of thetreated foot during the fusion period. If, however, the patient isnon-compliant and walks on the treated foot, the foot and bone plate aresubjected to undesirable bending forces.

Improved bone plates are desired.

SUMMARY

In some embodiments, an article comprises a unitary plate configured toconform to a foot of a patient. The unitary plate has a dorsal portionshaped to conform to a dorsal surface of a medial column of the foot anda plantar-medial portion shaped to conform to a medial surface of afirst metatarsal of the foot and extend to a plantar surface of thefirst metatarsal. The plantar-medial portion is integrally attached tothe dorsal portion. The unitary plate has a plurality of apertures forreceiving screws. The apertures include: a plurality of first aperturesthrough the dorsal portion, including one or more apertures adapted toreceive a respective one or more first screws to be inserted into adorsal surface of a talus of the foot, and at least one second apertureadapted to receive a second screw inserted through a plantar end of theplantar-medial portion into a first metatarsal of the foot.

A method comprises: fastening a unitary plate to a foot of a patient,the unitary plate having a dorsal portion that conforms to a dorsalsurface of a medial column of the foot and a plantar-medial portion thatconforms to a medial surface of a first metatarsal of the foot andextends to a plantar surface of the first metatarsal, the plantar-medialportion integrally attached to the dorsal portion, the fasteningincluding: inserting one or more screws through the dorsal portion intoa talus of the foot, and inserting at least one additional screw througha plantar end of the plantar-medial portion into a first metatarsal ofthe foot.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present disclosure aremore fully disclosed in, or rendered obvious by, the following detaileddescription, which is to be considered together with the accompanyingdrawings wherein like numbers refer to like parts and further wherein:

FIG. 1 is an isometric view of a medial-plantar medial tension boneplate according to an exemplary embodiment.

FIG. 2 is a top (dorsal) plan view of the bone plate of FIG. 1.

FIG. 3 is a cross-sectional view of the bone plate, taken along sectionline 3-3 of FIG. 2.

FIG. 4 is an anterior end elevation view of the bone plate of FIG. 1.

FIG. 5 is an exploded medial view of the bone plate of FIG. 1, withscrews for attachment to the medial column of a patient's foot.

FIG. 6 is a medial view showing the foot and bone plate of FIG. 5, withthe bone plate in position on the foot.

FIG. 7 is a medial view showing the foot with the bone plate in placeand screws inserted.

FIG. 8 is an anterior view of the foot with the plate implanted as shownin FIG. 7.

FIG. 9A is a lateral view of the foot with a plate according to a secondembodiment.

FIG. 9B shows the foot and plate of FIG. 9A with screws insertedtherein.

FIG. 10A is a plantar view of the foot and plate of FIG. 9A.

FIG. 10B shows the foot and plate of FIG. 10A with screws insertedtherein.

FIG. 11 is an anterior view of the foot and plate of FIG. 9A.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. In the description, relativeterms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,”“below,” “up,” “down,” “top” and “bottom” as well as derivative thereof(e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should beconstrued to refer to the orientation as then described or as shown inthe drawing under discussion. These relative terms are for convenienceof description and do not require that the apparatus be constructed oroperated in a particular orientation. Terms concerning attachments,coupling and the like, such as “connected” and “interconnected,” referto a relationship wherein structures are secured or attached to oneanother either directly or indirectly through intervening structures, aswell as both movable or rigid attachments or relationships, unlessexpressly described otherwise.

FIGS. 1-4 show an exemplary embodiment of a medial-plantarmedial-tension band plate 1100 for medial column arthrodesis. The boneplate 1100 can be used for medial column fusion or treatment offractures, arthritis or Charcot foot.

The plate is a unitary plate 1100 configured to conform to a foot 1110of a patient. The unitary plate 1100 has a dorsal portion 1102 shaped toconform to a dorsal surface 1106 of a medial column 1108 (FIG. 5) of thefoot 1110, and a plantar-medial portion 1104 shaped to conform to amedial surface 1112 of a first metatarsal 1114 of the foot 1110. Theplantar-medial portion 1104 is integrally attached to the dorsal portion1102 by the connecting portion 1105. The plantar-medial portion 1104 isshaped to extend to a plantar surface 1116 of the first metatarsal 1114.As shown in FIGS. 4 and 8, the plantar-medial portion 1104 wraps aroundthe medial surface of the first metatarsal 1114 in the plantardirection, creating a tension band with bone screws 1120 extending inapproximately orthogonal directions.

The unitary plate 1100 has a plurality of apertures 1118, 1130 forreceiving bone screws 1120. The apertures include first apertures 1118and one or more second apertures 1130. The bone screws 1120 can belocking or non-locking bone screws.

The dorsal portion 1102 of the plate 1100 has a plurality of firstapertures 1118 therethrough, including one or more apertures adapted toreceive a respective one or more first bone screws 1120 to be insertedinto a dorsal surface 1106 of a talus 1122 of the foot 1110. In someembodiments, the dorsal portion 1102 of the plate has a first (medial)row of first apertures 1118 and a second (lateral) row of firstapertures 1118. The first row and second row of first apertures 1118 areconfigured to receive bone screws, which can be locking screws 1120 ornon-locking screws. The second row of first apertures 1118 islongitudinally offset from the first row of first apertures 1118, toprovide several insertion locations for bone screws. For optimalstability, at least one bone screw is inserted through the firstapertures 1118 into each of the talus 1122, the navicular 1124, and thecuneiform 1126.

In some embodiments, the dorsal portion 1102 of the plate has a radius Ron its bottom surface (FIGS. 3 and 4), which is substantially constantfrom the posterior end of the plate 1100 to the anterior-most aperture1118 of the dorsal portion 1102. The radius can be the same for variousbone plate sizes having different posterior-anterior lengths. Forexample, in some embodiments, the radius size is 0.53 inch. This radiussize conforms comfortably to the dorsal surface of the bones 1122, 1124,1126. In various embodiments, the posterior-anterior length and numberof holes in the dorsal portion 1102 can be varied.

In some embodiments, the bone screws 1120 are 4 mm or 5.5 mm polyaxialscrews, which can be inserted at any angle with a cone subtending about15 degrees (e.g., from 13 to 17) from the center axis of the hole 1118.Polyaxial screws can be pointed in the direction towards the most densebone, for better fixation. In some embodiments, the bone screws 1120 areoteopenic screws with a larger thread pitch, and a larger thread heightbetween the major and minor diameters of the thread, which are favorablefor patients with soft or deteriorated bones, such as Charcot patients.

The plantar-medial portion 1104 of the bone plate 1100 has at least onesecond aperture 1130 adapted to receive a second bone screw 1121inserted through a plantar end of the plantar-medial portion 1104 into afirst metatarsal 1114 of the foot 1110.

In some embodiments, the plantar-medial portion 1104 further includes acompression slot 1131. The compression slot 1131 is proximate ananterior end of the unitary plate 1100, distal from the first apertures1118. In some embodiments, as shown in FIGS. 1 and 5-7, theplantar-medial portion 1104 has both a compression slot 1131 and atleast one second aperture 1130. The compression slot 1131 is placedclosest to the anterior end of the plantar-medial portion 1104 of theplate 1100. The compression slot 1131 has a ramped edge. The compressionslot 1131 is configured to receive a non-locking screw 1132 which can bedriven through the compression slot 1131 into the bone.

In some embodiments, the plantar-medial portion 1104 comprises anoblique portion extending in a posterior-medial direction, the obliqueportion configured to conform to the first metatarsal 1114 of the foot1110, and the second aperture 1130 is located in the oblique portion.

In some embodiments, the dorsal portion 1102 has a first average normaldirection N1 and the plantar-medial portion 1104 has a second averagenormal direction N2, and an angle γ between the first average normaldirection N1 and the second average normal direction N2 is about 95degrees or more.

In some embodiments, as best seen in FIG. 8, the first apertures 1118and second apertures 1130 are oriented relative to each other so that anangle α, β between one of the first bone screws 1120 and the second bonescrew 1121 after insertion is in a range from about 60 degrees to about120 degrees. In some embodiments, a respective angle α, β between thecompression screw and each of the one or more bone screws is in a rangefrom about 75 degrees to about 90 degrees.

In some embodiments, the plate 1100 comprises a titanium alloy with atype-2 surface anodization to improve the titanium fatigue properties.In some embodiments, the alloy composition is defined by the ASTMF136-13 Standard Specification for Wrought Titanium-6Aluminum-4VanadiumELI (Extra Low Interstitial) Alloy for Surgical Implant Applications(UNS R56401). In some embodiments, the plate has a thickness of 2.5 mm.In other embodiments, the plate can be thicker, or the plate 1100 cancomprise stainless steel.

In some embodiments, the unitary plate 1100 is fastened to the foot 1110as part of a medial column 1108 fusion for treating neuropathicosteoarthropathy. In some embodiments, the plate 1100 is used for aCharcot procedure. The plate 1100 can be inserted while the patient'sfoot is immobilized in a circular fixator or other external fixationdevice for the duration of fusion.

In some embodiments, for performing fusion the surgeon first trims thejoints of the medial column of the foot to remove cartilage.

The fixation method then comprises fastening a unitary plate 1100 to afoot 1110 of a patient. The unitary plate 1100 has a dorsal portion 1102that conforms to a dorsal surface 1106 of a medial column 1108 of thefoot 1110 and a plantar-medial portion 1104 that conforms to a medialsurface 1112 of a first metatarsal 1114 of the foot 1110 and extends toa plantar surface 1116 of the first metatarsal 1114. The plantar-medialportion 1104 is integrally attached to the dorsal portion 1102. In someembodiments, the fastening includes inserting one or more bone screws1120 through the dorsal portion 1102 into the talus 1122 of the foot1110.

In preparation, the surgeon threads a drill guide (not shown) into theapertures 1118 that are to receive bone screws 1120, and drills throughthe guide to the appropriate depth.

In some embodiments, one or two of the first bone screws 1120 are firstinserted through the most posterior holes 1118 into the talus 1122.

In some embodiments, a compression screw 1132 is then inserted through acompression slot 1131 in the plantar-medial portion 1104. In someembodiments, the step of inserting the compression screw 1132 causescompression of the medial column 1108, to compress all joints until thebones of the medial column start touching each other. The compressionslot 1131 has a ramped edge. A non-locking screw 1132 is positioned atthe most anterior (distal) end of the compression slot 1131 and driventhrough the compression slot 1131 into the bone. As the head of thenon-locking screw 1132 is driven into the compression slot 1131, thehead rides along the anterior ramp of the compression slot and centersitself in the aperture 1131, applying a force on the plate 1100 to pullthe posterior end of the plate (and the talus 1122) in the anteriordirection. The amount of tension can be determined by the geometry ofthe compression slot and its ramp. For example, in some embodiments, thecompression slot causes 5 mm of compression. That is, the bone screws1120 inserted through the dorsal portion 1102 of the plate 1100 aredrawn 5 mm closer to the anterior end of the first metatarsal 1114.

After inserting the compression screw 1132, at least one additional bonescrew 1121 is inserted through the aperture 1130 in the plantar end ofthe plantar-medial portion 1104, till the bone screw is inserted into afirst metatarsal 1114 of the foot 1110. The bone screw 1121 can be alocking screw or a non-locking screw. In some embodiments, the bonescrew 1121 is a polyaxial screw. In some embodiments, the bone screw isan osteopenic screw. In some embodiments, the bone screw 1121 isinserted from an angle δ of 15 to 20 degrees below the medial-lateralaxis ML, so that the insertion angle of bone screw 1121 has a dorsalcomponent of about 15 to about 20 degrees.

The surgeon inserts additional bone screws 1120 into the dorsal portion1102 of the plate. In some embodiments, the surgeon inserts a bone screw1120 into each of the remaining holes 1118 which overlies bone (and doesnot overlie a joint). In embodiments in which the dorsal portion 1102 ofthe plate has a first row of holes and a longitudinally offset secondrow of holes, the surgeon can insert one or more locking bone screws1120 through the first and second rows of holes, into one or more of thetalus 1122, navicular 1124 or cuneiform 1126 bones. The screws 1120 areplaced within a 30 degree purchase-cone so that bone screws 1120 alwayspurchase the bones of talus 1122, navicular 1124 and cuneiform 1126,i.e., always acquire a leveraged and secure engagement between thethreads on the surface of bone screw 1120 and the interior of the boneas the screw is rotated inwardly toward the bone.

In some embodiments, the step of inserting the one or more bone screwsincludes inserting at least one bone screw 1120 in each of the talus1122, the navicular 1124, and the cuneiform 1126. In some embodiments,the step of inserting the one or more bone screws includes inserting atleast two bone screws 1120 in each of the talus 1122, the navicular1124, and the cuneiform 1126. In some embodiments, two bone screws areinserted into each bone 1122, 1124, 1126, including one bone screw inthe first longitudinal row, and one bone screw in the secondlongitudinal row.

In some embodiments, in which the plantar-medial portion 1104 comprisesan oblique portion 1103 extending in a posterior-medial direction, theoblique portion 1103 conforms to the first metatarsal 1114, and the atleast one additional bone screw 1121 is a locking bone screw 1120inserted into the oblique portion 1103.

In some embodiments, a respective angle α, β between the compressionscrew and each of the one or more bone screws is in a range from about60 degrees and about 120 degrees.

In some embodiments, the dorsal portion 1102 has a first average normaldirection N1 and the plantar-medial portion 1104 has a second averagenormal direction N2, and the bone screws 1120 inserted through the holes1118 in the dorsal portion 1102 are separated from the bone screw(s)1121 inserted into the plantar-medial portion 1104 by an angle γ ofabout 90 to about 95 degrees. In some embodiments, the angle γ is about95 degrees (e.g., 93 or 97 degrees).

The plates described herein can be applied for either medial column orlateral column arthrodesis. The same plate 1100 can be used in theposition shown in FIGS. 1-8 for medial column arthrodesis, with thedorsal portion 1102 of the plate on the dorsal side of the foot.Alternatively, the plate can be rotated approximately 180 degrees (aboutits anterior-posterior axis) and used for lateral column arthrodesis.When used for lateral column arthrodesis, the portion 1102 is applied tothe lateral side of the foot, and the portion 1104 is applied to theplantar-lateral side of the foot.

The plates described herein can also be varied in length. In someembodiments, the same length plate 1100 can be used for medial columnand lateral column fixation. In other embodiments plates of differentlength can be used for medial column and lateral column fixation. Asurgeon can select the length of the plate based on the size and densityof the patient's bones. In some embodiments, the same size and shape ofportion 1104 can be used while varying the length of the portion 1102.

FIGS. 9A to 11 show a second embodiment of the plate 1200, which isshorter in length than the plate 1100. FIGS. 9A-11 show the use of theplate 1200 for lateral column arthrodesis. As discussed above, the sameplate 1200 could also be used for medial column arthrodesis, by rotatingthe plate 180 degrees about the anterior posterior axis. As shown inFIGS. 9A-11, in some embodiments, the plate 1200 is used for cuboidfixation with screws 1120 inserted into the calcaneus 1109 and/or talus1113 with a lateral to medial approach, and screws inserted into thecuboid with a plantar to dorsal approach. The plate 1200 has a cuboidportion 1204 with the same size and shape as the plantar-medial portion1104 of the plate 1100 described above, but has a lateral portion 1202which is shorter than the dorsal portion 1102 of the plate 1100. Forexample, in plate 1100, the dorsal portion 1102 is long enough toinclude four locking holes 1118 in each row. In plate 1200, the lateralportion 1202 is long enough to include two locking holes 1118 in eachrow. In other respects, the configuration of the plate 1200 is similarto that of the plate 1110.

FIGS. 9A-11 show the plate 1200, rotated about 90 degrees from theposition of plate 1100 in FIG. 6. The lateral portion 1202 of plate 1200is mainly positioned on the lateral side of the foot, whereas thecorresponding dorsal portion 1102 of the plate 1100 is mainly positionedon the medial side of the foot. The cuboid portion 1204 of plate 1200 ismainly positioned on the plantar-lateral side of the foot, whereas thecorresponding plantar-medial portion 1104 of the plate 1100 is mainlypositioned on the plantar-medial side of the foot.

The plate 1200 is a unitary plate configured to conform to a foot 1110of a patient. The unitary plate 1200 has a lateral portion 1202 shapedto conform to a lateral surface calcaneus 1109 of the foot 1110, and acuboid portion 1204 shaped to conform to a plantar surface of the cuboid1111 of the foot 1110. The cuboid portion 1204 is integrally attached bythe connecting portion 1205 to the lateral portion 1202. The cuboidportion 1204 is shaped to extend to a plantar surface of the cuboidbone. As shown in FIGS. 9A-11, the cuboid portion 1204 wraps around thelateral surface of the cuboid bone 1111 and then extends in a posteriordirection along the calcaneus 1109, creating a tension band with bonescrews 1120, 1121 extending in approximately orthogonal directions.

The unitary plate 1200 has a plurality of apertures 1118, 1130 forreceiving bone screws 1120. The apertures include first apertures 1118and one or more second apertures 1130. The bone screws 1120 can belocking or non-locking bone screws.

The lateral portion 1202 of the plate 1200 has a plurality of firstapertures 1118 therethrough, including one or more apertures adapted toreceive a respective one or more first bone screws 1120 to be insertedinto a lateral surface of a calcaneus 1109 and/or talus 1113. In someembodiments, the lateral portion 1202 of the plate has a first row offirst apertures 1118 and a second row of first apertures 1118. The firstrow and second row of first apertures 1118 are configured to receivebone screws, which can be locking screws 1120 or non-locking screws. Thesecond row of first apertures 1118 is longitudinally offset from thefirst row of first apertures 1118, to provide several insertionlocations for bone screws. For optimal stability, at least one bonescrew is inserted through the first apertures 1118 into the calcaneus1109 and at least one of the talus or the navicular.

In some embodiments, the lateral portion 1202 of the plate has a radiusR on its inner surface (best seen in FIG. 11), which is substantiallyconstant from the posterior end of the plate 1200 to the anterior-mostaperture 1118 of the lateral portion 1202. The radius can be the samefor various bone plate sizes having different posterior-anteriorlengths. For example, in some embodiments, the radius size is 0.53 inch(the same as the radius of the portion 1102 of plate 1100). This radiussize conforms comfortably to the lateral surface of the bones 1109,1113. In various embodiments, the posterior-anterior length and numberof holes in the lateral portion 1202 can be varied.

The cuboid portion 1204 of the bone plate 1200 has at least one secondaperture 1130 adapted to receive a second bone screw 1121 insertedthrough a distal (anterior) end of the cuboid portion 1204 into thecuboid bone 1111 of the foot 1110.

In some embodiments, the cuboid portion 1204 further includes acompression slot 1131. The compression slot 1131 is proximate ananterior end of the unitary plate 1200. In some embodiments, as shown inFIGS. 9A-11, the cuboid portion 1204 has both a compression slot 1131and at least one second aperture 1130. The compression slot 1131 isplaced closest to the proximal (posterior) end of the cuboid portion1204 of the plate 1200. The compression slot 1131 has a ramped edge. Thecompression slot 1131 is configured to receive a non-locking screw 1132which can be driven through the compression slot 1131 into the cuboidbone 1111.

In some embodiments, the cuboid portion 1204 comprises an obliqueportion extending in a posterior-plantar direction, the oblique portionconfigured to conform to the calcaneus 1109 of the foot 1110, and thecompression slot 1131 is located in the oblique portion. The secondaperture 1130 is located in a horizontal portion.

In some embodiments, as best seen in FIG. 11, the first apertures 1118and second apertures 1130 are oriented relative to each other so that anangle between one of the first bone screws 1120 and the second bonescrew 1121 after insertion is in a range from about 60 degrees to about120 degrees. In some embodiments, a respective angle between thecompression screw and each of the one or more bone screws is in a rangefrom about 75 degrees to about 90 degrees.

In some embodiments, as best seen in FIG. 11, the lateral portion 1202has a first average normal direction 1231 and the plantar portion 1204has a second average normal direction 1230, and an angle 1232 betweenthe first average normal direction and the second average normaldirection is about 95 degrees.

In other respects, such as material selection and fabrication methods,the plate 1200 can be the same as the plate 1100. The procedure usingthe plate 1200 is similar to that described above with respect to plate1100, except for the positioning of the plate 1200 and screws, 1120,1121, 1132.

In some embodiments, after positioning the plate 1200 as show in FIGS.9A-11, a compression screw 1132 is inserted through the compression slot1131 in the plantar portion 1204 and into the cuboid bone 1111. In someembodiments, the step of inserting the compression screw 1132 causescompression of the lateral column, to compress the joint until thecuboid and calcaneus start touching each other. The compression slot1131 has a ramped edge. A non-locking screw 1132 is positioned at themost anterior (distal) end of the compression slot 1131 and driventhrough the compression slot 1131 into the bone 1109. As the head of thenon-locking screw 1132 is driven into the compression slot 1131, thehead rides along the anterior ramp of the compression slot and centersitself in the aperture 1131, applying a force on the plate 1200 to pullthe posterior end of the plate (and the calcaneus 1109) in the anteriordirection. The amount of tension can be determined by the geometry ofthe compression slot and its ramp. For example, in some embodiments, thecompression slot causes 5 mm of compression. That is, the bone screws1120 inserted through the lateral portion 1202 of the plate 1200 aredrawn 5 mm closer to the anterior end of the fifth metatarsal.

After inserting the compression screw 1132, at least one additional bonescrew 1121 is inserted through the aperture 1130 in the distal(anterior) end of the plantar portion 1204, till the bone screw isinserted into the cuboid of the foot 1110. The bone screw 1121 can be alocking screw or a non-locking screw. In some embodiments, the bonescrew 1121 is a polyaxial screw. In some embodiments, the bone screw isan osteopenic screw. In some embodiments, the bone screw 1121 isinserted from an angle δ of 15 to 20 degrees below the dorsal-plantaraxis, so that the insertion angle of bone screw 1121 has a lateralcomponent of about 15 to about 20 degrees.

The surgeon inserts additional bone screws 1120 into the lateral portion1202 of the plate 1200. In some embodiments, the surgeon inserts a bonescrew 1120 into each of the remaining holes 1118 which overlies bone(and does not overlie a joint). In embodiments in which the lateralportion 1202 of the plate has a first row of holes and a longitudinallyoffset second row of holes, the surgeon can insert one or more lockingbone screws 1120 through the first and second rows of holes, into one ormore of the talus 1122, navicular 1124 or cuneiform 1126 bones. Thescrews 1120 are placed within a 30 degree purchase-cone so that bonescrews 1120 always purchase the bones of talus 1122, navicular 1124and/or cuneiform 1126, i.e., always acquire a leveraged and secureengagement between the threads on the surface of bone screw 1120 and theinterior of the bone as the screw is rotated inwardly toward the bone.

In some embodiments, the step of inserting the one or more bone screwsincludes inserting at least one bone screw 1120 in each of the talus1122, the navicular 1124, and the cuneiform 1126. In some embodiments,the step of inserting the one or more bone screws includes inserting atleast two bone screws 1120 in each of the talus 1122, the navicular1124, and the cuneiform 1126. In some embodiments, two bone screws areinserted into each bone 1122, 1124, 1126, including one bone screw inthe first longitudinal row, and one bone screw in the secondlongitudinal row.

Although an example of a shorter plate 1200 is shown and described forcuboid fixation, a longer plate, similar in length to the plate 1100, ora plate (not shown) having six apertures 1118 on the lateral portion1202 can be used in the position shown in FIGS. 9A to 11, for fixationof the entire lateral column. For example the plate can be positioned sothat the plantar portion is placed against the fifth metatarsal. Thesurgeon inserts a bone screw 1120 through the posterior-most aperture1118 into the calcaneus. Insertion of the compression screw 1132 intothe fifth metatarsal causes the fifth metatarsal, cuboid and calcaneusto draw together.

Although the examples described above use a relatively long plate 1100for the dorsal and medial sides of the foot and a relatively short plate1200 for the lateral and plantar sides of the foot, in otherembodiments, shorter plates can be used on the dorsal side of the foot,and longer plates can be used on the medial or lateral side.

Although the drawings show a left-foot version of the plates 1100, 1200,right-foot versions of the plates 1100, 1200 are provided as the mirrorimage of the plates 1100, 1200 with respect to a vertical plane that isnormal to the medial-lateral axis.

The plates 1100 and 1200 described herein provide a larger, more stablestructure that is advantageous for advanced midfoot reconstruction. Theplates described herein can be used in combination with any of a varietyof external and/or internal fixation devices. For example, the plate1100 can be used in combination with external fixation devices such as,but not limited to a cast or a circular fixator; the plates 1100 and1200 can be used in combination with internal fixation devices such as,but not limited to a medial column wire or beam. The plates 1100 and1200 aid in keeping the respective medial and lateral columns fusedwhile also handling large loads applied to the midfoot.

Although the subject matter has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodiments,which may be made by those skilled in the art.

What is claimed is:
 1. A method comprising: fastening a unitary plate toa foot of a patient, the unitary plate having a dorsal portion thatconforms to a dorsal surface of a medial column of the foot and aplantar-medial portion that conforms to a medial surface of a firstmetatarsal of the foot and extends to a plantar surface of the firstmetatarsal, the plantar-medial portion integrally attached to the dorsalportion, the fastening including: inserting one or more screws throughthe dorsal portion into a talus of the foot, and inserting at least oneadditional screw through a proximal end of the plantar-medial portioninto a first metatarsal of the foot, wherein the dorsal portion of theplate has a first row of holes and a second row of holes, the first andsecond rows of holes are configured to receive locking screws, and thesecond row of holes is longitudinally offset from the first row ofholes.
 2. The method of claim 1, further comprising inserting acompression screw through a compression slot in the plantar-medialportion.
 3. The method of claim 2, wherein the step of inserting thecompression screw causes compression of the medial column.
 4. The methodof claim 1, wherein the plantar portion comprises an oblique portionextending in a posterior-medial direction, the oblique portionconforming to the first metatarsal, and the at least one additionalscrew is a locking screw.
 5. The method of claim 4, wherein the lockingscrew is a polyaxial screw.
 6. The method of claim 4, wherein thelocking screw is an osteopenic screw.
 7. The method of claim 1, whereinthe foot has a navicular and a cuneiform, and the step of inserting theone or more screws includes inserting at least one screw in each of thetalus, the navicular, and the cuneiform.
 8. The method of claim 1,wherein the dorsal portion has a first average normal direction and theplantar-medial portion has a second average normal direction, and anangle between the first average normal direction and the second averagenormal direction is about 95 degrees.
 9. The method of claim 1, whereinthe unitary plate is fastened to the foot as part of a medial columnfusion for treating neuropathic osteoarthropathy.
 10. A methodcomprising: fastening a unitary plate to a foot of a patient, theunitary plate having a lateral portion that conforms to a lateralsurface of a lateral column of the foot and a plantar portion thatconforms to a plantar surface of a cuboid bone of the foot and extendsat least to a plantar surface of the cuboid bone, the plantar portionintegrally attached to the lateral portion, the fastening including:inserting one or more screws through the lateral portion into acalcaneus of the foot, and inserting at least one additional screwthrough a plantar proximal end of the plantar portion into the cuboidbone of the foot, wherein the lateral portion of the plate has a firstrow of holes and a second row of holes, the first and second rows ofholes are configured to receive locking screws, and the second row ofholes is longitudinally offset from the first row of holes.
 11. Themethod of claim 10, further comprising inserting a compression screwthrough a compression slot in the plantar portion, so as to causecompression of the medial column.
 12. The method of claim 10, whereinthe lateral portion has a first average normal direction and the plantarportion has a second average normal direction, and an angle between thefirst average normal direction and the second average normal directionis about 95 degrees.
 13. The method of claim 10, wherein the unitaryplate is fastened to the foot as part of a medial column fusion fortreating neuropathic osteoarthropathy.